Journal of Internal Medicine Concepts & Practice >
Analysis of clinical characteristics of biliary hyperlipidemic pancreatitis
Online published: 2022-07-25
Objective To study the clinical characteristics of biliary pancreatitis(BAP), hyperlipidemic pancreatitis (HLAP) and biliary hyperlipidemic pancreatitis(BHAP). Methods The patients diagnosed with acute pancreatitis in the emergency department of our hospital from January 2013 to June 2017 were studied retrospectively. The patients were divided into BAP, HLAP and BHAP groups according to the causes. The clinical data including age, sex, admission ward, time of onset, comorbidities, severity, organ support and inflammatory biomarkers were compared. The clinical prognosis parameters of patients in each group, such as hospitalization time, operation rate and mortality, were also analyzed. Results A total of 286 patients with acute pancreatitis were included. The clinical information of the patients in three groups were analyzed with pairwise comparison, and the results showed that the age of onset in both BHAP group and HLAP group was younger than that in BAP group(P<0.01). The comparison of procalcitonin(PCT) on admission showed that its level in BHAP group was significantly higher than that in the other two types of pancreatitis(P<0.01). In terms of organ support, the patients among three groups showed significant differences in mechanical ventilation (P<0.05), renal replacement therapy (P<0.01), and the use of vasoactive drugs (P<0.05). In terms of severity, the results of pairwise comparison among groups showed as follows: the modified Marshall score, BHAP group>BAP group (P<0.05); acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score and sequential organ failure assessment (SOFA) score, BHAP group>BAP group>HLAP group (P<0.01); bedside index for severity in acute pancreatitis (BISAP), BHAP group>HLAP group (P<0.01) and BAP group>HLAP group (P<0.05); computed tomography severity index (CTSI), BHAP group>BAP group (P<0.05) and BHAP group>HLAP group(P<0.01). In terms of prognosis, the comparison of hospital stays among three groups showed that it was longer in BHAP group than that in HLAP group(P<0.01). Conclusions BAP, HLAP and BHAP have different clinical characteristics. The patients of BHAP combined with biliary tract and hyperlipidemia are more likely to develop into severe pancreatitis, and have longer hospital stays.
CHE Zaiqian, ZHAO Bing, WANG Yihui, ZHU Huihui, WANG Yuming, QI Xing, LI Mengjiao, CHEN Ying, MA Li, CHEN Erzhen, MAO Enqiang . Analysis of clinical characteristics of biliary hyperlipidemic pancreatitis[J]. Journal of Internal Medicine Concepts & Practice, 2022 , 17(01) : 58 -62 . DOI: 10.16138/j.1673-6087.2022.01.011
[1] | Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer[J]. Gastroenterology, 2013, 144(6): 1252-1261. |
[2] | Zhu Y, Pan X, Zeng H, et al. A study on the etiology, severity, and mortality of 3260 patients with acute pancreatitis according to the revised atlanta classification in Jiangxi, China over an 8-year period[J]. Pancreas, 2017, 46(4): 504-509. |
[3] | 徐海峰, 李勇, 颜骏, 等. 急性胰腺炎病因与其严重程度的关系[J]. 中华医学杂志, 2014, 94(41): 3220-3223. |
[3] | Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus[J]. Gut, 2013, 62(1): 102-111. |
[4] | Tsuang W, Navaneethan U, Ruiz L, et al. Hypertrigly-ceridemic pancreatitis: presentation and management[J]. Am J Gastroenterol, 2009, 104(4): 984-991. |
[5] | Wang YH, Xu ZH, Zhou YH, et al. The clinical characteristic of biliary-hyperlipidemic etiologically complex type of acute pancreatitis: a retrospective study from a tertiary center in China[J]. Eur Rev Med Pharmacol Sci, 2021, 25(3): 1462-1471. |
[6] | 毛恩强. 重症急性胰腺炎急性反应期强化治疗的要点[J]. 肝胆外科杂志, 2011, 19(4): 244-246. |
[7] | Marshall JC, Cook DJ, Christou NV, et al. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome[J]. Crit Care Med, 1995, 23(10): 1638-1652. |
[8] | 车在前, 赵冰, 王义辉, 等. 联合使用BISAP和改良MarshaII评分对急性胰腺炎死亡率的预测价值[J]. 内科理论与实践, 2020, 15(6): 400-404. |
[9] | Lee SP, Nicholls JF, Park HZ. Biliary sludge as a cause of acute pancreatitis[J]. N Engl J Med, 1992, 326(9): 589-593. |
[10] | Owyang C, Levitt M. Chronic pancreatitis[M]// Textbook of gastroenterology. New York: JB Lippincott, 1874: 199. |
[11] | Shaka H, Asotibe JC, Achebe I, et al. Higher inpatient morbidity and mortality in biliary pancreatitis compared to hypertriglyceridemia-induced pancreatitis[J]. Cureus, 2020, 12(9): e10351. |
[12] | de Oliveira C, Khatua B, Noel P, et al. Pancreatic triglyceride lipase mediates lipotoxic systemic inflammation[J]. J Clin Invest, 2020, 130(4): 1931-1947. |
[13] | Mayer JM, Raraty M, Slavin J, et al. Serum amyloid A is a better early predictor of severity than C-reactive protein in acute pancreatitis[J]. Br J Surg, 2002, 89(2):163-171. |
[14] | 车在前, 赵冰, 王义辉, 等. 降钙素原预测急性胆源性胰腺炎患者死亡的临床价值[J]. 中华胰腺病杂志, 2020, 2(2): 114-119. |
[15] | 毛恩强. 重症急性胰腺炎急性反应期的“强化治疗方案”的进展[J]. 国际外科学杂志, 2014, 41(6): 369-371. |
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